I am exaggerating slightly but not by much. For the past month, the amount of insulin my son needs to use to bring his hormone peaks down has exploded, increasing by about 5x. Yesterday, he had a peak at school that required 30 units to bring down. On a day with no peaks (which pretty much never happens) that is his TDD.
It is really difficult to bring such peaks down in a timely manner without some overcorrection.
[Translation: either it takes us a long time to bring them down or we are typically overcorrect and eat tons of carb, such as a meal’s worth)]
This is the same challenge I often have. Highs just stay high without a TON of insulin to bring them down. But it’s difficult to tell at the beginning what type of high it’ll be…a high that will respond to one correction, or a high that will need multiple massive corrections. If I could somehow tell right at the beginning that this would be a stubborn high I’d hit it with a 3x normal bolus and it would really help in being able to bring highs down more quickly! I think for me part of the problem is hormones, but part of the problem is also that being high in and of itself can create insulin resistance (and even more insulin resistance if there are ketones).
I’m not sure. I just know that if ketones are high, you’re supposed to give additional insulin above and beyond what you’d normally use for a correction (usually something like 10-20% of the TDD, I think).
I think it is because, when you have ketones, they worry that you are on your way to DKA, so they are ready to increase the correction dosage. Normally they are just paranoid of lows so this is an exception.
Are you guys in (or have you been in) the stage where you’ve needed to re-define Bolus / Basal rates? Or are these highs/lows so sporadic that they aren’t causing a defined pattern?
@Michel Not that it’s the same thing, but this eerily reminds me of the difficulties I was having a few months ago that turned out to be a basal problem.
If I find myself correcting all day for more than 24 hours, I up my basal rates (and often other pump settings). But hormones are tricky. They’re not always consistent.
Also, I’m not sure if your son is on a pump, but in the past I’ve had times hwere I’ve used my entire TDD in corrections and then changed sites and suddenly reverted back to normal. This happened just a few days ago, I ran at 250-400+ for two days even with constant corrections and +100% basal rates running. I was ready to blame it on hormones and increase all my pump settings, but as soon as I changed to a new site, things went back to normal. I use metal sets, so it wasn’t a kinked cannula, but clearly insulin wasn’t being absorbed very well.
@Michel If you haven’t done it recently, it may be worthwhile to do a DIA test and a carb absorption rate test. When I did this a few months ago I was astonished that novolog had an almost eight hour tail for me. The fact that this problem is contiguous with starting the pump could point to novolog as the basal insulin being at fault.
When the insulin regimen was Regular and NPH, this was the cause of most problems. The graphs that these calculations will produce can be very revealing.
Actually, I think the reason they recommend more insulin is that they are assuming that there isn’t enough insulin for your body to use the glucose pathway and your body has switched to the fat metabolism pathway, and you give extra insulin to encourage the body to go back to the “normal” glucose pathway, while giving lots of fluids to dilute and flush the ketones.
I got a flu-type bug for the last 3 days and have spent a ton of time in the 200s (xmas cookies + sick). With some dips down to the 40’s when I hit it too hard or fall asleep before I hit the threshold to eat a little and flatten out the dive (first time the dex has read “lo” and it was actually true)… First time dealing with being sick. Not feeling good = not motivated to do math and think hard about dosages, so I’ve pretty much been running high and giving myself a unit or 2 when I creep above 150/200.
IMO, this has to be one of the most annoying things about diabetes. The times when it needs the most attention are the times you’re feeling the worst. Most other conditions might have a doctor taking care of treatment during times you feel crappy, but not our disease.
